Provider Demographics
NPI:1326454208
Name:DIAMOND HEAD DENTAL CARE
Entity Type:Organization
Organization Name:DIAMOND HEAD DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-286-1714
Mailing Address - Street 1:3045 MONSARRAT AVE
Mailing Address - Street 2:UNIT 7
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-4400
Mailing Address - Country:US
Mailing Address - Phone:808-735-8883
Mailing Address - Fax:
Practice Address - Street 1:3045 MONSARRAT AVE
Practice Address - Street 2:UNIT 7
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-4400
Practice Address - Country:US
Practice Address - Phone:808-735-8883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI21551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty